A process for quantifying aesthetic and functional breast surgery: II. Applying quantified dimensions of the skin envelope to design and preoperative planning for mastopexy and breast reduction.

BACKGROUND A previous submission defined methods to objectively define nipple position and vertical and horizontal skin excess in mastopexy and breast reduction. This article defines a set of second-stage processes for quantified design and operative planning for skin envelope modification. METHODS A skin envelope modification procedure (periareolar, periareolar plus vertical, or periareolar plus vertical plus horizontal) was selected based on the quantified amount of vertical skin excess. This process was applied in 124 consecutive mastopexy and 122 consecutive breast reduction cases. Average follow-up was 4.6 years (range, 6 to 14 years). RESULTS All cases were assessed, planned, and executed applying the processes in this article. No patient required nipple repositioning. Complications included excessive lower pole restretch (4 percent), periareolar scar hypertrophy (0.8 percent), hematoma (1.2 percent), and areolar shape irregularities (1.6 percent). Delayed healing at the junction of vertical and horizontal scars occurred in two reduction patients [two of 124 (1.6 percent)], neither of which required revision. The overall reoperation rate was 6.5 percent (16 of 246) for patients in the first 5 years of the study and decreased to 1.6 percent for patients from year 6 through year 14. CONCLUSIONS This study defines processes for using objectively defined parameters for skin envelope modification in mastopexy and breast reduction. Quantifying desired skin envelope design enables surgeons to objectively quantify vertical skin excess and horizontal skin excess, select envelope modification design and techniques based on those parameters, and evaluate outcomes based on objective clinical measurements in both mastopexy and breast reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.